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Myocardial function in aortic stenosis--insights from radial multilayer Doppler strain.

Cramariuc D, Gerdts E, Hjertaas JJ, Cramariuc A, Davidsen ES, Matre K - Cardiovasc Ultrasound (2015)

Bottom Line: Radial strain was lower in the subepicardial layer (33.4 ± 38.6%) compared to the mid-myocardial and subendocardial layers (50.3 ± 37.3% and 53.0 ± 40.0%, respectively, both p < 0.001 vs. subepicardial).In the subendo- and midmyocardium, radial strain was lower in patients with severe AS compared to those with non-severe AS (p < 0.05).In multivariate regression analyses including age, heart rate, inferior wall thickness, hypertension, and AS severity, radial strain in the mid-myocardium was primarily attenuated by presence of hypertension (β = -0.23) and AS severity (β = -0.26, both p < 0.05), while radial strain in the subendocardium was significantly influenced by AS severity only (β = -0.35, p < 0.01).

View Article: PubMed Central - PubMed

Affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. cramariuc_dana@yahoo.com.

ABSTRACT

Background: Left ventricular (LV) radial tissue Doppler imaging (TDI) strain increases gradually from the subepicardial to the subendocardial layer in healthy individuals. A speckle tracking echocardiography study suggested this gradient to be reduced in parallel with increasing aortic stenosis (AS) severity.

Methods: We used TDI strain in 84 patients with AS (mean age 73 ± 10 years, 56% hypertensive) for superior assessment of layer strain. 38 patients had non-severe and 46 severe AS by aortic valve area corrected for pressure recovery. Peak systolic radial TDI strain was measured in the subendocardial, mid-myocardial and subepicardial layers of the basal inferior LV wall, each within a region of interest of 2 × 6 mm (strain length 2 mm).

Results: Radial strain was lower in the subepicardial layer (33.4 ± 38.6%) compared to the mid-myocardial and subendocardial layers (50.3 ± 37.3% and 53.0 ± 40.0%, respectively, both p < 0.001 vs. subepicardial). In the subendo- and midmyocardium, radial strain was lower in patients with severe AS compared to those with non-severe AS (p < 0.05). In multivariate regression analyses including age, heart rate, inferior wall thickness, hypertension, and AS severity, radial strain in the mid-myocardium was primarily attenuated by presence of hypertension (β = -0.23) and AS severity (β = -0.26, both p < 0.05), while radial strain in the subendocardium was significantly influenced by AS severity only (β = -0.35, p < 0.01).

Conclusions: In AS, both the AS severity and concomitant hypertension attenuate radial TDI strain in the inferior LV wall. The subendocardial radial strain is mainly influenced by AS severity, while midmyocardial radial strain is attenuated by both hypertension and AS severity.

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Related in: MedlinePlus

Comparison of peak radial systolic strain (vertical axis) in three myocardial layers (subendocardium: EndoS, mid-myocardium: MidS, and subepicardium: EpiS) in the four left ventricular (LV) geometric groups (horizontal axis). P <0.05 for comparison of EndoS between patients with normal LV geometry vs. concentric LV hypertrophy.
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Fig3: Comparison of peak radial systolic strain (vertical axis) in three myocardial layers (subendocardium: EndoS, mid-myocardium: MidS, and subepicardium: EpiS) in the four left ventricular (LV) geometric groups (horizontal axis). P <0.05 for comparison of EndoS between patients with normal LV geometry vs. concentric LV hypertrophy.

Mentions: EndoS was significantly lower in patients with concentric LV geometry: 43.8 ± 36.1 vs. 66.4 ± 42.0 (p < 0.05). When compared between the four LV geometric groups, EndoS was lowest in patients with concentric LV hypertrophy, and highest in those with normal LV geometry (Figure 3). MidS and EpiS did not differ significantly between different LV geometric groups (Figure 3).Figure 3


Myocardial function in aortic stenosis--insights from radial multilayer Doppler strain.

Cramariuc D, Gerdts E, Hjertaas JJ, Cramariuc A, Davidsen ES, Matre K - Cardiovasc Ultrasound (2015)

Comparison of peak radial systolic strain (vertical axis) in three myocardial layers (subendocardium: EndoS, mid-myocardium: MidS, and subepicardium: EpiS) in the four left ventricular (LV) geometric groups (horizontal axis). P <0.05 for comparison of EndoS between patients with normal LV geometry vs. concentric LV hypertrophy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4340885&req=5

Fig3: Comparison of peak radial systolic strain (vertical axis) in three myocardial layers (subendocardium: EndoS, mid-myocardium: MidS, and subepicardium: EpiS) in the four left ventricular (LV) geometric groups (horizontal axis). P <0.05 for comparison of EndoS between patients with normal LV geometry vs. concentric LV hypertrophy.
Mentions: EndoS was significantly lower in patients with concentric LV geometry: 43.8 ± 36.1 vs. 66.4 ± 42.0 (p < 0.05). When compared between the four LV geometric groups, EndoS was lowest in patients with concentric LV hypertrophy, and highest in those with normal LV geometry (Figure 3). MidS and EpiS did not differ significantly between different LV geometric groups (Figure 3).Figure 3

Bottom Line: Radial strain was lower in the subepicardial layer (33.4 ± 38.6%) compared to the mid-myocardial and subendocardial layers (50.3 ± 37.3% and 53.0 ± 40.0%, respectively, both p < 0.001 vs. subepicardial).In the subendo- and midmyocardium, radial strain was lower in patients with severe AS compared to those with non-severe AS (p < 0.05).In multivariate regression analyses including age, heart rate, inferior wall thickness, hypertension, and AS severity, radial strain in the mid-myocardium was primarily attenuated by presence of hypertension (β = -0.23) and AS severity (β = -0.26, both p < 0.05), while radial strain in the subendocardium was significantly influenced by AS severity only (β = -0.35, p < 0.01).

View Article: PubMed Central - PubMed

Affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. cramariuc_dana@yahoo.com.

ABSTRACT

Background: Left ventricular (LV) radial tissue Doppler imaging (TDI) strain increases gradually from the subepicardial to the subendocardial layer in healthy individuals. A speckle tracking echocardiography study suggested this gradient to be reduced in parallel with increasing aortic stenosis (AS) severity.

Methods: We used TDI strain in 84 patients with AS (mean age 73 ± 10 years, 56% hypertensive) for superior assessment of layer strain. 38 patients had non-severe and 46 severe AS by aortic valve area corrected for pressure recovery. Peak systolic radial TDI strain was measured in the subendocardial, mid-myocardial and subepicardial layers of the basal inferior LV wall, each within a region of interest of 2 × 6 mm (strain length 2 mm).

Results: Radial strain was lower in the subepicardial layer (33.4 ± 38.6%) compared to the mid-myocardial and subendocardial layers (50.3 ± 37.3% and 53.0 ± 40.0%, respectively, both p < 0.001 vs. subepicardial). In the subendo- and midmyocardium, radial strain was lower in patients with severe AS compared to those with non-severe AS (p < 0.05). In multivariate regression analyses including age, heart rate, inferior wall thickness, hypertension, and AS severity, radial strain in the mid-myocardium was primarily attenuated by presence of hypertension (β = -0.23) and AS severity (β = -0.26, both p < 0.05), while radial strain in the subendocardium was significantly influenced by AS severity only (β = -0.35, p < 0.01).

Conclusions: In AS, both the AS severity and concomitant hypertension attenuate radial TDI strain in the inferior LV wall. The subendocardial radial strain is mainly influenced by AS severity, while midmyocardial radial strain is attenuated by both hypertension and AS severity.

Show MeSH
Related in: MedlinePlus